Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2005018058 | MO |
N | 225XP0200X | Occupational Therapist - Pediatrics | 2005018058 | MO |
NPI | 1043501430 |
---|---|
Provider Name | Nancy Hoedl |
First Address | Springfield, MO 65810-3114 |
Second Address | Springfield, MO 65810-3114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 20/04/2011 |